In Haiti, two different humanitarian groups have built new factories to make this product, which is used to treat severe malnutrition and maybe someday prevent it. The problem is, Haiti doesn't appear to need two of them. Each factory, all by itself, could satisfy Haiti's current demand.

This tale of two factories is also the story of two organizations with the same mission. It's also about the strange economy of philanthropy, with its mixture of altruism and self-promotion.

Pat Wolff, a pediatrician from St. Louis, set it up almost a decade ago, specifically to make that special peanut-based treatment for malnutrition in Haiti. She started small, in a rented house in Cap-Haitien, grinding peanuts and mixing them with sugar, dried milk, oil and lots of minerals and vitamins.

PIH — Partners in Health — is much bigger than MFK, and it's world-famous for its work fighting AIDS in some of the world's poorest countries. Its founder, Paul Farmer, is one of the most charismatic figures in the whole field of global public health.

"They said, 'Oh, what a great idea; tell us more about that,' " Wolff says. "And we were totally transparent to them."

Wolff and her colleagues shared their recipes, their technologies, and PIH soon set up its own kitchen-scale production of enriched peanut butter, which it calls Nourimanba. PIH uses it to treat patients at its own clinics in central and western Haiti.

Then Meds and Food for Kids decided to do this on a much bigger scale. It raised $3.2 million, about $700,000 of which is a loan, and it built a factory. It just got up and running a few months ago. It has white clean rooms and expensive machinery made of stainless steel that spits out little foil-wrapped packages of enriched peanut butter.

UNICEF buys the product and distributes it to hospitals and clinics all over Haiti.

According to Wolff, this factory "can make everything that's needed for the whole country of Haiti."

Enter The Competitors

But now, Partners in Health is building its own factory. That factory is just as big, if not bigger. It's funded by a $6 million grant from Abbot Laboratories. If all goes according to plan, it will be up and running by the end of the year.

Jonathan Lascher, who's managing this project for PIH, insists that his organization is not competing with MFK. Partners in Health, he says, will not sell its product to UNICEF or the World Food Program. It will pass out this treatment for free to people who need it, in the regions of Haiti where PIH is active.

"I certainly think there are ample opportunities for MFK's operations to scale up, to meet most of the demand across the country," he says, and there will be opportunities for PIH to do other things. For instance, there will be so much excess capacity at PIH's new factory that the organization is considering using it to make commercial peanut butter, too. PIH could sell that product to help cover the factory's costs.

In any case, Lascher says, PIH decided to go ahead with its own factory in order to provide opportunities for peanut farmers in PIH's home area, in Haiti's central plateau. "When that center opens, farmers around that area are going to know that this center is a beacon of economic opportunity. They can bring their peanuts, and we'll purchase them."

Lascher and his colleagues at Partners in Health don't seem threatened by MFK's factory; it doesn't affect their plans much.

Meds and Food for Kids, on the other hand, is much smaller and financially more fragile. It does appear threatened.

"There's not enough local peanuts, and not enough need for this product in Haiti, to have two factories that hope to be sustainable into the future," says Wolff.

It's not just that a second factory could cut into MFK's sales. Wolff's colleagues say PIH's project also has sucked away funders and consultants who were donating their technical expertise.

Of course, the important question is probably not whether a second factory is good for MFK, but whether it's good for the people of Haiti.

NGO Businesses Are Just Like Other Businesses

We called up someone who knows both organizations: Mark Manary, a professor of pediatrics at Washington University in St. Louis. He's a pioneer in this field. Years ago, in Africa, he first showed Wolff how to make this peanut-based treatment for malnutrition. When PIH was thinking about building its new factory, people from that organization asked Manary for advice.

Manary doesn't really take sides. But, he says, looking at the situation from the outside, it does seem like a waste of money. "It seems like [having] two factories isn't appropriate for Haiti."

This kind of thing happens, he says, because nongovernmental organizations end up behaving like all other organizations. They compete; they try to attract recognition and funding, and to promote their own brand.

"Unfortunately, branding is a powerful force among many NGOs," he says. "And it is basically true, I think, that once an organization exists, it tries to survive." But that can prevent it from cooperating with other organizations, or stepping aside to let another organization thrive.

Manary says he understands that impulse, because he has tried to build an organization, too. But it can distract an organization from the people it's really trying to help.

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Transcript

RENEE MONTAGNE, HOST:

For the past several weeks, Haitians have been holding protests around the country, demonstrating against corruption, unemployment and food shortages, which brings us to the third part of NPR's series on food aid in Haiti.

STEVE INSKEEP, HOST:

Two different humanitarian groups are building big factories in the country to manufacture a kind of enriched peanut butter. It is a life-saving product. It's used to treat severe malnutrition in children. The problem is Haiti doesn't need two factories. Each one, by itself, could satisfy the country's current demand. NPR's Dan Charles brings us a story of altruism and competition.

DAN CHARLES, BYLINE: This tale of two factories is also the story of two organizations. Both are dedicated to improving the lives of people in Haiti. The first one is Meds and Food for Kids, or MFK. It was founded by a pediatrician from St. Louis, Pat Wolff. She set it up to make a special kind of peanut butter for malnourished children. That peanut butter includes also sugar, oil, powdered milk and lots of minerals and vitamins - just a simple recipe, but it saves lives. MFK started small in a rented house in Cap-Haitien on the country's northern coast.

PAT WOLFF: We started doing this in 2003. And in 2006, PIH contacted us.

CHARLES: PIH, Partners in Health, is the second organization in this story. It's much bigger than MFK and it's world-famous for its work treating AIDS in poor countries. Its founder, Paul Farmer, is one of the most charismatic figures in the whole field of global public health.

WOLFF: They said, oh, what a great idea. Tell us more about that, and we were totally transparent to them.

CHARLES: Wolff and her colleagues shared their recipes, their technologies, and Partners in Health soon set up its own kitchen-scale production of enriched peanut butter to hand out to patients in its clinics in central Haiti. Then Pat Wolff and Meds and Food for Kids decided to do this on a much bigger scale.

They raised $3 million - part of which they'll need to pay back with interest - and they built a factory. They just got it running a few months ago. MFK's Jamie Rhoads shows me expensive machinery made of stainless steel in white, clean rooms spitting out little, foil-wrapped packages of life-saving peanut butter.

JAMIE RHOADS: In the world of industrial food production, it's probably not, you know, the top-of-the-line, most sophisticated thing, but certainly for here and from what we started at, hand-grinding things, this is space-age technology

CHARLES: It has to be high-tech to meet the quality and purity standards set by international organizations like UNICEF. UNICEF buys this product and distributes it to hospitals and clinics all over Haiti. Pat Wolff says now UNICEF doesn't need to import it from France or the U.S.

WOLFF: We can make everything that's needed for the whole country of Haiti.

CHARLES: Except that Partners in Health is now building a factory, too, just as big. That factory is funded by a $6 million grant from Abbot Laboratories, the pharmaceutical company

JOEL MALEBRANCHE: You can hear my voice echo, it's so big.

CHARLES: Joel Malebranche from Partners in Health is standing inside a cavernous cinder block shell. In a few months, if all goes well, there will be machines here, churning out that miracle peanut paste.

MALEBRANCHE: So it's really exciting, the prospect that we're going to be have an opportunity to help all the kids that suffer from malnutrition in all our sites.

CHARLES: Now, Jonathan Lascher from Partners in Health insists his organization is not competing with MFK. We won't sell our product to UNICEF or the World Food Program, he says. We'll pass it out for free just to people in the regions of Haiti that we serve.

JONATHAN LASCHER: I certainly think there are ample opportunities for both MFK's operations to scale up their production facility, to meet most of the demand across the country.

CHARLES: And there are opportunities for our factory to do other things, he says. For instance, we'll have so much excess capacity, maybe we'll make regular commercial peanut butter, too. We might sell it to help keep the operation afloat, financially. In any case, Lascher says, we want our own factory, so we can provide opportunities for peanut farmers in our home area, in Haiti's central plateau.

LASCHER: When that center opens, farmers around the area are going to know that this center is a beacon of economic opportunity for them to bring their peanuts, and we'll purchase them.

CHARLES: Lascher and his colleagues at Partners in Health don't seem threatened by MFK's factory. It doesn't affect their plans much. Meds and Food for Kids, though, is much smaller, financially more fragile, and it does feel threatened. Here's MFK's founder, Pat Wolff.

WOLFF: There's not enough local peanuts, and there's not enough need for this product in Haiti, to have two factories that hope to be sustainable into the future.

CHARLES: It's not just that her factory could lose sales, people at MFK say PIH's factory project also has sucked away funders and consultants who were donating their technical expertise.

Still, even if a second factory isn't good for MFK, the more important question probably is: could it be good for the people of Haiti?

I called up someone who knows both organizations, Mark Manary, a professor of pediatrics at Washington University in St. Louis. He was one of the first to use this peanut butter cure for malnutrition. He first showed MFK's Pat Wolff how to make it years ago in Africa. And when PIH was thinking about building their new factory, they asked Manary for advice.

Manary doesn't really take sides. But he says as far as I can tell what's going on here does seem like a waste of money.

MARK MANARY: It seems like the, you know, two factories isn't appropriate for Haiti.

CHARLES: This kind of thing happens, he says, because NGOs - non-governmental organizations - are well, they're organizations. They compete; they do things that will attract recognition and promote their own brand.

MANARY: Unfortunately, branding is a powerful force among many NGOs. And it is basically true, I think, that once an organization exists, it tries to survive.

CHARLES: But that can also prevent it from cooperating with others or stepping aside to let another organization thrive. I understand that impulse, he says. I've tried to build an organization, too. But it can distract you from the people you're really trying to help.